Journal of The Korean Society of Clinical Toxicology

CT Findings of Perforation of the Stomach after Ingestion of Glacial Acetic Acid: Hohyun Kim, Seok Ran Yeom, Hyun Min Cho, Kwang-Hee Yeo, Jae-Hun Kim; J Korean Soc Clin Toxicol. 2018;16(2):161-164. Published online December 31, 2018; DOI: https://doi.org/10.22537/jksct.2018.16.2.161

Abstract PDF: The ingestion of corrosive substances often leads to severe morbidity and mortality. Acids produce coagulation necrosis with a lesser degree of penetration, whereas alkalis produce liquefactive necrosis with penetration. Acetic acid is a clear, colorless organic acid with a pungent, vinegar-like odor. The ingestion of highly concentrated acetic acid (glacial acetic acid) may cause a range of complications. On the other hand, perforation of the stomach is extremely rare but it has a high mortality rate. This paper reports a case of perforation of the stomach after the ingestion of glacial acetic acid with suicidal intent in an otherwise healthy 76-year-old woman.

The Clinical Characteristics and Prognosis after Acute Ingestion of Glacial Acetic Acid: Gab-Yong Choi, Young-Gi Min, Yoon-Seok Jung, Joon-Pil Cho, Sang-Cheon Choi; J Korean Soc Clin Toxicol. 2012;10(2):91-96. Published online December 31, 2012

Abstract PDF: Purpose: A retrospective study with a literature review was conducted to identify the clinical characteristics and prognosis after the acute ingestion of glacial acetic acid. Methods: The medical records of 20 patients,who had presented to the emergency department of Ajou University Hospital complaining of the acute ingestion of glacial acetic acid between January 2006 and December 2011, were examined retrospectively. Results: Among the 172 patients admitted for caustics injury, 20 patients ingested glacial acetic acid. The mean age of the patients was $55{pm}23.5$, and the mean volume of the acid was $84.5{pm}71.3$ ml. The clinical features included 1) oral ulcers in 12 patients (63.2%), 2) respiratory difficulties in 11 patients (57.9%), 3) oliguria in 8 patients (42.1%), 4) renal toxicity in 7 patients (36.8%), 5) hepatic failure in 7 patients (36.8%), 6) disseminated intravascular boagulopathyin 7 patients (36.8%), 7) low blood pressure in 8 patients (42.1%), and 8) mental changes in 9 patients (47.4%). Ten patients required endotracheal intubation. Nine patients were admitted to the intensive care unit, and 5 patients expired. Conclusion: The ingestion of glacial acetic acid can cause severe symptoms, such as metabolic acidosis, multiple organ failure and upper airway swelling frequently and has a high mortality rate. Therefore, aggressive treatment, including endotracheal intubation, should be considered at the early stages.

A Case Report of Glacial Acetic Acid Ingestion Complicated with Hepatic Necrosis: Yeon Young Kyong, Mi Jin Lee, Seung Pil Choi, Kyu Nam Park, Won Jae Lee, Se Kyung Kim; J Korean Soc Clin Toxicol. 2004;2(1):23-26. Published online June 30, 2004

Abstract PDF: Caustic ingestion can produce a progressive and fatal injuries to esophagus, stomach and other organs. Reported exposure to acetic acid results injuries to gastrointestinal tract, hemolysis and disseminated intravascular coagulation is general, but causing hepatic necrosis by direct injuries are rare. A 47-year-old man visited our emergency medical center complaining odynophagia and abdominal pain after ingesting glacial acetic acid ($99\%$) with suicidal ideation. At the time of arrival, the patient complained mild abdominal pain but a few hours later the patient complained severe abdominal pain with markedly elevated liver enzymes. The Abdominal Computerized Tomography showed diffuse gastric wall edema and density of wedge shaped hypodense area in right hepatic dome showing focal hepatic necrosis without significant inflammation. This seems likely to be a direct effect of the noxious agent on hepatocyte involving the portal circulation.

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